Clinical outcomes and mortality in old and very old patients undergoing cardiac resynchronization therapy
Cardiac resynchronization therapy (CRT) is a valid therapeutic option for patients with heart failure (HF). However, the elderly population was not well represented in the guidelines. The primary end point was to evaluate the impact of advanced age on clinical response and cardiovascular and total m...
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| Veröffentlicht in: | PloS one 2019-12, Vol.14 (12), p.e0225612-e0225612 |
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| creator | Montenegro Camanho, Luiz Eduardo Benchimol Saad, Eduardo Slater, Charles Oliveira Inacio Junior, Luiz Antonio Vignoli, Gustavo Carvalho Dias, Lucas Pimenta de Mello Spineti, Pedro Mourilhe-Rocha, Ricardo |
| description | Cardiac resynchronization therapy (CRT) is a valid therapeutic option for patients with heart failure (HF). However, the elderly population was not well represented in the guidelines. The primary end point was to evaluate the impact of advanced age on clinical response and cardiovascular and total mortality of patients undergoing CRT. The secondary end point was to assess the rate of acute complications related to the procedure.
A total of 249 consecutive patients with HF and optimized treatment, QRS ≥ 120 ms, ejection fraction (EF) ≤ 35% and functional class (FC) III/ IV (NYHA) underwent CRT and divided into 3 groups: Group I-< 65 years-88/ 249 (35%); Group II- 65 to 75 years (old)- 72/ 249 (29%); Group III-≥ 75 years (very old)- 89/ 249 (36%). The improvement in FC and increase in EF (>10%) and/ or decrease in the left ventricular end systolic diameter (LVESD) >15% were the criteria of responsiveness. The favorable clinical response (p = ns) and cardiovascular mortality (p = 0.737) was similar in the 3 groups. In the group of very old patients, a significant increase in total mortality was observed (p = 0.03). The rate of acute complications related to the procedure did not differ between the groups (p = ns).
The response to CRT and cardiovascular mortality were not affected by the advanced age and should not be an exclusion factor of this therapy. The procedure has been shown to be safe in elderly patients due to low rate of acute complications. |
| doi_str_mv | 10.1371/journal.pone.0225612 |
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A total of 249 consecutive patients with HF and optimized treatment, QRS ≥ 120 ms, ejection fraction (EF) ≤ 35% and functional class (FC) III/ IV (NYHA) underwent CRT and divided into 3 groups: Group I-< 65 years-88/ 249 (35%); Group II- 65 to 75 years (old)- 72/ 249 (29%); Group III-≥ 75 years (very old)- 89/ 249 (36%). The improvement in FC and increase in EF (>10%) and/ or decrease in the left ventricular end systolic diameter (LVESD) >15% were the criteria of responsiveness. The favorable clinical response (p = ns) and cardiovascular mortality (p = 0.737) was similar in the 3 groups. In the group of very old patients, a significant increase in total mortality was observed (p = 0.03). The rate of acute complications related to the procedure did not differ between the groups (p = ns).
The response to CRT and cardiovascular mortality were not affected by the advanced age and should not be an exclusion factor of this therapy. The procedure has been shown to be safe in elderly patients due to low rate of acute complications.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0225612</identifier><identifier>PMID: 31790460</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Age ; Age Factors ; Aged ; Aged, 80 and over ; Biology and Life Sciences ; Cardiac patients ; Cardiac Resynchronization Therapy - adverse effects ; Cardiac Resynchronization Therapy Devices - adverse effects ; Cardiac Tamponade - epidemiology ; Cardiac Tamponade - etiology ; Cardiovascular diseases ; Clinical outcomes ; Complications ; Congestive heart failure ; Defibrillators ; Defibrillators, Implantable - adverse effects ; Elderly patients ; Engineering and Technology ; Female ; Follow-Up Studies ; Geriatrics ; Heart failure ; Heart Failure - mortality ; Heart Failure - therapy ; Humans ; Life expectancy ; Male ; Medicine and Health Sciences ; Middle Aged ; Mortality ; Older people ; Patient outcomes ; Patients ; People and Places ; Pneumothorax - epidemiology ; Pneumothorax - etiology ; Population ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Prosthesis Implantation - adverse effects ; Research and Analysis Methods ; Therapy ; Treatment Outcome ; Ventricle</subject><ispartof>PloS one, 2019-12, Vol.14 (12), p.e0225612-e0225612</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Montenegro Camanho et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Montenegro Camanho et al 2019 Montenegro Camanho et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-81e0d394b09953edcb7c7d0cae13aee10924c5eec626152d7987fefc823692b3</citedby><cites>FETCH-LOGICAL-c692t-81e0d394b09953edcb7c7d0cae13aee10924c5eec626152d7987fefc823692b3</cites><orcidid>0000-0001-5333-7174</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886771/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886771/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31790460$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Montenegro Camanho, Luiz Eduardo</creatorcontrib><creatorcontrib>Benchimol Saad, Eduardo</creatorcontrib><creatorcontrib>Slater, Charles</creatorcontrib><creatorcontrib>Oliveira Inacio Junior, Luiz Antonio</creatorcontrib><creatorcontrib>Vignoli, Gustavo</creatorcontrib><creatorcontrib>Carvalho Dias, Lucas</creatorcontrib><creatorcontrib>Pimenta de Mello Spineti, Pedro</creatorcontrib><creatorcontrib>Mourilhe-Rocha, Ricardo</creatorcontrib><title>Clinical outcomes and mortality in old and very old patients undergoing cardiac resynchronization therapy</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Cardiac resynchronization therapy (CRT) is a valid therapeutic option for patients with heart failure (HF). However, the elderly population was not well represented in the guidelines. The primary end point was to evaluate the impact of advanced age on clinical response and cardiovascular and total mortality of patients undergoing CRT. The secondary end point was to assess the rate of acute complications related to the procedure.
A total of 249 consecutive patients with HF and optimized treatment, QRS ≥ 120 ms, ejection fraction (EF) ≤ 35% and functional class (FC) III/ IV (NYHA) underwent CRT and divided into 3 groups: Group I-< 65 years-88/ 249 (35%); Group II- 65 to 75 years (old)- 72/ 249 (29%); Group III-≥ 75 years (very old)- 89/ 249 (36%). The improvement in FC and increase in EF (>10%) and/ or decrease in the left ventricular end systolic diameter (LVESD) >15% were the criteria of responsiveness. The favorable clinical response (p = ns) and cardiovascular mortality (p = 0.737) was similar in the 3 groups. In the group of very old patients, a significant increase in total mortality was observed (p = 0.03). The rate of acute complications related to the procedure did not differ between the groups (p = ns).
The response to CRT and cardiovascular mortality were not affected by the advanced age and should not be an exclusion factor of this therapy. The procedure has been shown to be safe in elderly patients due to low rate of acute complications.</description><subject>Age</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biology and Life Sciences</subject><subject>Cardiac patients</subject><subject>Cardiac Resynchronization Therapy - adverse effects</subject><subject>Cardiac Resynchronization Therapy Devices - adverse effects</subject><subject>Cardiac Tamponade - epidemiology</subject><subject>Cardiac Tamponade - etiology</subject><subject>Cardiovascular diseases</subject><subject>Clinical outcomes</subject><subject>Complications</subject><subject>Congestive heart failure</subject><subject>Defibrillators</subject><subject>Defibrillators, Implantable - adverse effects</subject><subject>Elderly patients</subject><subject>Engineering and Technology</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Geriatrics</subject><subject>Heart failure</subject><subject>Heart Failure - mortality</subject><subject>Heart Failure - therapy</subject><subject>Humans</subject><subject>Life expectancy</subject><subject>Male</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Older people</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>People and Places</subject><subject>Pneumothorax - epidemiology</subject><subject>Pneumothorax - etiology</subject><subject>Population</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Prosthesis Implantation - adverse effects</subject><subject>Research and Analysis Methods</subject><subject>Therapy</subject><subject>Treatment Outcome</subject><subject>Ventricle</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk11r2zAUhs3YWLtu_2BshsHYLpLpw5btm0IJ-wgUClvZrZClY0dBkTJJLst-_ZTELfHoxTDG8vHzvufoWCfLXmM0x7TCn9Zu8FaY-dZZmCNCSobJk-wcN5TMGEH06cn6LHsRwhqhktaMPc_OKK4aVDB0numF0VZLYXI3ROk2EHJhVb5xPgqj4y7XNndGHYJ34HeHl62IGmwM-WAV-N5p2-dSeKWFzD2EnZUr76z-kzBn87gCL7a7l9mzTpgAr8bnRXb75fPt4tvs-ubrcnF1PZOsIXFWY0CKNkWLmqakoGRbyUohKQBTAYBRQwpZAkhGGC6Jqpq66qCTNaFJ39KL7O3Rdmtc4GOTAieUoJpSjItELI-EcmLNt15vhN9xJzQ_BJzvufBRSwNcKIIVZqggJRRl07aNrErSpluRVCFKXpdjtqHdpGJTV7wwE9PpF6tXvHd3nNU1qyqcDD6MBt79GiBEvtFBgjHCghvGuquiQDSh7_5BH9_dSPUibUDbzqW8cm_KrxiqaFnVdJ92_giVLgUbLdOJ6nSKTwQfJ4LERPgdezGEwJc_vv8_e_Nzyr4_YVcgTFwFZ4b9yQlTsDiC0rsQPHQPTcaI7wfivht8PxB8HIgke3P6gx5E9xNA_wL8fwa6</recordid><startdate>20191202</startdate><enddate>20191202</enddate><creator>Montenegro Camanho, Luiz Eduardo</creator><creator>Benchimol Saad, Eduardo</creator><creator>Slater, Charles</creator><creator>Oliveira Inacio Junior, Luiz Antonio</creator><creator>Vignoli, Gustavo</creator><creator>Carvalho Dias, Lucas</creator><creator>Pimenta de Mello Spineti, Pedro</creator><creator>Mourilhe-Rocha, Ricardo</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-5333-7174</orcidid></search><sort><creationdate>20191202</creationdate><title>Clinical outcomes and mortality in old and very old patients undergoing cardiac resynchronization therapy</title><author>Montenegro Camanho, Luiz Eduardo ; Benchimol Saad, Eduardo ; Slater, Charles ; Oliveira Inacio Junior, Luiz Antonio ; Vignoli, Gustavo ; Carvalho Dias, Lucas ; Pimenta de Mello Spineti, Pedro ; Mourilhe-Rocha, Ricardo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-81e0d394b09953edcb7c7d0cae13aee10924c5eec626152d7987fefc823692b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Age</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biology and Life Sciences</topic><topic>Cardiac patients</topic><topic>Cardiac Resynchronization Therapy - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Montenegro Camanho, Luiz Eduardo</au><au>Benchimol Saad, Eduardo</au><au>Slater, Charles</au><au>Oliveira Inacio Junior, Luiz Antonio</au><au>Vignoli, Gustavo</au><au>Carvalho Dias, Lucas</au><au>Pimenta de Mello Spineti, Pedro</au><au>Mourilhe-Rocha, Ricardo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical outcomes and mortality in old and very old patients undergoing cardiac resynchronization therapy</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-12-02</date><risdate>2019</risdate><volume>14</volume><issue>12</issue><spage>e0225612</spage><epage>e0225612</epage><pages>e0225612-e0225612</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Cardiac resynchronization therapy (CRT) is a valid therapeutic option for patients with heart failure (HF). However, the elderly population was not well represented in the guidelines. The primary end point was to evaluate the impact of advanced age on clinical response and cardiovascular and total mortality of patients undergoing CRT. The secondary end point was to assess the rate of acute complications related to the procedure.
A total of 249 consecutive patients with HF and optimized treatment, QRS ≥ 120 ms, ejection fraction (EF) ≤ 35% and functional class (FC) III/ IV (NYHA) underwent CRT and divided into 3 groups: Group I-< 65 years-88/ 249 (35%); Group II- 65 to 75 years (old)- 72/ 249 (29%); Group III-≥ 75 years (very old)- 89/ 249 (36%). The improvement in FC and increase in EF (>10%) and/ or decrease in the left ventricular end systolic diameter (LVESD) >15% were the criteria of responsiveness. The favorable clinical response (p = ns) and cardiovascular mortality (p = 0.737) was similar in the 3 groups. In the group of very old patients, a significant increase in total mortality was observed (p = 0.03). The rate of acute complications related to the procedure did not differ between the groups (p = ns).
The response to CRT and cardiovascular mortality were not affected by the advanced age and should not be an exclusion factor of this therapy. The procedure has been shown to be safe in elderly patients due to low rate of acute complications.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31790460</pmid><doi>10.1371/journal.pone.0225612</doi><tpages>e0225612</tpages><orcidid>https://orcid.org/0000-0001-5333-7174</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2019-12, Vol.14 (12), p.e0225612-e0225612 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2320833114 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Age Age Factors Aged Aged, 80 and over Biology and Life Sciences Cardiac patients Cardiac Resynchronization Therapy - adverse effects Cardiac Resynchronization Therapy Devices - adverse effects Cardiac Tamponade - epidemiology Cardiac Tamponade - etiology Cardiovascular diseases Clinical outcomes Complications Congestive heart failure Defibrillators Defibrillators, Implantable - adverse effects Elderly patients Engineering and Technology Female Follow-Up Studies Geriatrics Heart failure Heart Failure - mortality Heart Failure - therapy Humans Life expectancy Male Medicine and Health Sciences Middle Aged Mortality Older people Patient outcomes Patients People and Places Pneumothorax - epidemiology Pneumothorax - etiology Population Postoperative Complications - epidemiology Postoperative Complications - etiology Prosthesis Implantation - adverse effects Research and Analysis Methods Therapy Treatment Outcome Ventricle |
| title | Clinical outcomes and mortality in old and very old patients undergoing cardiac resynchronization therapy |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-08T20%3A16%3A25IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Clinical%20outcomes%20and%20mortality%20in%20old%20and%20very%20old%20patients%20undergoing%20cardiac%20resynchronization%20therapy&rft.jtitle=PloS%20one&rft.au=Montenegro%20Camanho,%20Luiz%20Eduardo&rft.date=2019-12-02&rft.volume=14&rft.issue=12&rft.spage=e0225612&rft.epage=e0225612&rft.pages=e0225612-e0225612&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0225612&rft_dat=%3Cgale_plos_%3EA607357831%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2320833114&rft_id=info:pmid/31790460&rft_galeid=A607357831&rft_doaj_id=oai_doaj_org_article_ad21d160425e459bb9c752b752d24b00&rfr_iscdi=true |